Nasal dorsal aesthetic lines and rhinoplasty technical tricks

Abstract

Rhinoplasty surgery remains one of the most difficult operations of the face. Improving aesthetic appearance and maintaining nasal function are inseparable goals in rhinoplasty surgery, and failure to achieve either of these objectives can be devastating for the patient. After evaluating a variety of rhinoplasty complications, increased attention was devoted to the surgical technique for reconstruction of the dorsal aesthetic lines and nasal tip projection in the patient with a prominent dorsal hump. Based on the modern concept of cartilage conservation, the autospreader flap rotation technique should be considered when dorsal reduction is required. Autospreader flaps are a useful tool in the prevention of postoperative nasal obstruction, segmental (inverted V) appearance, midfacial axial asymmetry and an overdone supratip break. In addition, they assist in preserving ethnicity of the nose when desired. The patient with a long nose, prominent dorsal hump, short nasal bones and low lower lateral cartilages are considered to be an ideal candidate for an autospreader flap.

Keywords

Autospreader flap / nasal aesthetic anatomy / nasal dorsal aesthetic lines / open rhinoplasty / spreader graft

References

[1] Nahai F.Your favorite technique: time for a change?.Aesthetic Surg J2012;32:900-2

[2] Nahai F.Evidence-based medicine in aesthetic surgery..Aesthetic Surg J2011;31:135-6

[3] Gunter JP.Gunter JP,Adams WPJr.Clinical assessment and facial analysis..Dallas Rhinoplasty: Nasal Surgery by the Masters.2002;St. LouisQuality Medical Publishing53-71

[4] Sajjadian A.Primary rhinoplasty..Aesthetic Surg J2010;30:527-39

[5] Becker DG,Guy C.Surgical treatment of nasal obstruction in rhinoplasty..Aesthetic Surg J2010;30:347-78

[6] Guyuron B.Soft tissue functional anatomy of the nose..Aesthetic Surg J2006;26:733-5

[7] Palhazi P,Kosins AM.The osseocartilaginous vault of the nose: anatomy and surgical observations..Aesthetic Surg J2015;35:242-51

[8] Rohrich RJ,Janis JE.Component dorsal hump reduction: the importance of maintaining dorsal aesthetic lines in rhinoplasty..Plast Reconstr Surg2004;114:1298-308

[9] Wang ZJ,Yang HM.Investigation of the layers and vascular density of the soft tissue in the inferior nasal portion..Zhonghua Zheng Xing Wai Ke Za Zhi2007;23:65-8

[10] Cakir B,Dogan T.A complete subperichondrial dissection technique for rhinoplasty with management of the nasal ligaments..Aesthetic Surg J2012;32:564-74

[11] Kim SK,Lee KC.Correction of the supratip deformity of the nose..Aesthetic Surg J2012;32:943-55

[12] Guyuron B,Lash R.Supratip deformity: a closer look..Plast Reconstr Surg2000;105:1140-51

[13] Ponsky D,Guyuron B.The frequency of surgical maneuvers during open rhinoplasty..Plast Reconstr Surg2010;126:240-4

[14] Gruber RP,Pomerantz J.Suture techniques for the nasal tip..Aesthetic Surg J2008;28:92-100

[15] Daniel RK.Tip refinement grafts: the designer tip..Aesthetic Surg J2009;29:528-37

[16] Gruber RP,Woodward JF.Dorsal reduction and spreader flaps..Aesthetic Surg J2011;31:456-64

[17] Sheen JH.Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty..Plast Reconstr Surg1984;73:230-9

[18] Byrd HS,Gonyon DL, Jr..Using the autospreader flap in primary rhinoplasty..Plast Reconstr Surg2007;119:1897-902

[19] Manavbasi YI.The role of upper lateral cartilage in dorsal reconstruction after hump excision: section1. Spreader flap modification with asymmetric mattress suture and extension of the spreading effect by cartilage graft..Aesthetic Plast Surg2011;35:487-93

[20] Oneal RM.Upper lateral cartilage spreader flaps in rhinoplasty..Aesthetic Surg J1998;18:370-1

[21] Rohrich RJ.The dorsal columellar strut: innovative use of dorsal hump removal for a columellar strut..Aesthetic Surg J2010;30:30-5

[22] Aston SJ.A plastic surgeon's evolution..IPRAS J2011;(6):33-4

[23] Spiro SA,Wider TM.The use of the labiocolumellar crease incision in rhinoplasty..Ann Plast Surg1996;37:569-76

[24] Yagmur C,Akbas H.Spreader flap correction of dorsal septal deviations..Aesthetic Surg J2015;35:345-8